• Rhiannon D Reed, McLeodM ChandlerMCComprehensive Transplant Institute, University of Alabama at Birmingham, AL., Paul A MacLennan, Vineeta Kumar, Sydney E Pittman, Andrew G Maynor, Luke A Stanford, Gavin A Baker, Carrie A Schinstock, John R Silkensen, Garrett R Roll, Dorry L Segev, Babak J Orandi, Cora E Lewis, and Jayme E Locke.
• Comprehensive Transplant Institute, University of Alabama at Birmingham, AL.
• Ann. Surg. 2023 Jul 1; 278 (1): e115e122e115-e122.

ObjectiveTo examine whether body mass index (BMI) changes modify the association between kidney donation and incident hypertension.BackgroundObesity increases hypertension risk in both general and living kidney donor (LKD) populations. Donation-attributable risk in the context of obesity, and whether weight change modifies that risk, is unknown.MethodsNested case-control study among 1558 adult LKDs (1976-2020) with obesity (median follow-up: 3.6 years; interquartile range: 2.0-9.4) and 3783 adults with obesity in the Coronary Artery Risk Development in Young Adults (CARDIA) and Atherosclerosis Risk in Communities (ARIC) studies (9.2 y; interquartile range: 5.3-15.8). Hypertension incidence was compared by donor status using conditional logistic regression, with BMI change investigated for effect modification.ResultsOverall, LKDs and nondonors had similar hypertension incidence [incidence rate ratio (IRR): 1.16, 95% confidence interval (95% CI): 0.94-1.43, P =0.16], even after adjusting for BMI change (IRR: 1.25, 95% CI: 0.99-1.58, P =0.05). Although LKDs and nondonors who lost >5% BMI had comparable hypertension incidence (IRR: 0.78, 95% CI: 0.46-1.34, P =0.36), there was a significant interaction between donor and >5% BMI gain (multiplicative interaction IRR: 1.62, 95% CI: 1.15-2.29, P =0.006; relative excess risk due to interaction: 0.90, 95% CI: 0.24-1.56, P =0.007), such that LKDs who gained weight had higher hypertension incidence than similar nondonors (IRR: 1.83, 95% CI: 1.32-2.53, P <0.001).ConclusionsOverall, LKDs and nondonors with obesity had similar hypertension incidence. Weight stability and loss were associated with similar hypertension incidence by donor status. However, LKDs who gained >5% saw increased hypertension incidence versus similar nondonors, providing support for counseling potential LKDs with obesity on weight management postdonation.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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